Quality statement 4: Regular HIV testing

Quality statement

Young people and adults in at-risk groups who test negative for HIV are advised that the test should be repeated at least annually.

Rationale

Regular HIV testing for people in groups or communities at risk of HIV exposure is important to reduce late diagnosis. People who test negative for HIV may continue to be at risk and regular testing will ensure early diagnosis. Early diagnosis will improve treatment outcomes and reduce the risk of transmission to other people. People who have unprotected sex with new or casual partners are at high risk of exposure and should be advised to have an HIV test more often than once a year.

Quality measures

Structure

a) Evidence of local processes to identify if young people and adults who test negative for HIV are in at-risk groups.

Data source: Local data collection, for example, service protocol.

b) Evidence of local processes to advise young people and adults in at-risk groups who test negative for HIV that the test should be repeated at least annually.

Data source: Local data collection, for example, service protocol.

Process

Proportion of young people and adults in at-risk groups who test negative for HIV who are advised that the test should be repeated at least annually.

Numerator – the number in the denominator who are advised that the test should be repeated at least annually.

Denominator – the number of young people and adults in at-risk groups who test negative for HIV.

Data source: Local data collection, for example, an audit of patient health records or report from recall system.

Outcome

a) Proportion of young people and adults in at-risk groups who had an HIV test in the past 12 months.

Numerator – the number in the denominator who had an HIV test in the past 12 months.

Denominator – the number of young people and adults in at-risk groups.

Data source: Local data collection, for example, an audit of patient health records. Data on timing of most recent HIV test is available from Public Health England's Genitourinary medicine clinic activity dataset.

b) Number of new HIV diagnoses in at-risk groups.

Data source: Local data collection for Public Health England's HIV and AIDS reporting system.

c) Number of new HIV diagnoses made at a late stage of infection in at-risk groups.

Data source: Local data collection for Public Health England's HIV and AIDS reporting system. Late stage of infection is defined as a CD4 count less than 350 cells per mm3.

What the quality statement means for different audiences

Service providers (such as sexual health clinics, hospitals, general practices and community HIV testing services) ensure that processes are in place to identify young people and adults in at-risk groups who test negative for HIV and to advise them that the test should be repeated at least annually and more often if they are at high risk of exposure.

Healthcare practitioners (such as sexual health advisers, doctors and nurses and lay testers) identify young people and adults in at-risk groups who test negative for HIV and advise them that the test should be repeated at least annually and more often if they are at high risk of exposure. If people are reluctant to have an HIV test at least annually, healthcare professionals should provide information on how to access other local HIV testing services, including those that offer less invasive forms of specimen collection and self-sampling.

Commissioners (local authorities, clinical commissioning groups and NHS England) commission services that identify young people and adults in at-risk groups who test negative for HIV and advise them that the test should be repeated at least annually.

Young people and adults who have a negative HIV test but who may still be at risk of exposure are advised that the HIV test should be repeated at least annually. This is so that they can be diagnosed and treated as early as possible if they become infected.

Source guidance

HIV testing: increasing uptake among people who may have undiagnosed HIV (2016) NICE guideline NG60, recommendation 1.2.6

Definitions of terms used in this quality statement

Young people and adults

Young people are aged 16 and 17 years. Adults are aged 18 years and over.

[Expert opinion]

At-risk groups

HIV testing should be recommended to people in the following groups:

  • people from a country or group with a high rate of HIV infection

  • men who have sex with men

  • trans women who have sex with men

  • people who have had sexual contact with someone from a country with a high rate of HIV or someone with a high risk of HIV (for example, female sexual contacts of men who have sex with men)

  • people who participate in high-risk sexual practices such as 'chemsex'

  • people who are diagnosed with or tested for a sexually transmitted infection

  • drug users who inject.

[Adapted from NICE's guideline on HIV testing, recommendations 1.1.5 and 1.1.8 and expert opinion]